[Health] The Infectious Diseases Thread

[mori]

Did anyone else think of this scene from Outbreak when the Blackhawk was approaching the cruise ship?

[Alefroth]

As every news source is reminding us, we now have over 100K confirmed cases.

China's new case by day continues to fall. 102 new cases in past 24 hours.

Iran's case count is now getting REALLY scary... 1234 new cases in past 24 hours, that's 33% gain from yesterday.

Korea is holding steady at under 500. Italy went up by over 700 cases per day.

US gained 65 new cases, right now 11 deaths out of 213 confirmed cases means death rate is over 5%. But that just suggests that US has vast number of undiagnosed cases. Given that CDC only tested like 1500 or so cases virtually confirmed it. Now that CDC is trusting individual states trusted labs to run more tests, expect the confirmed cases to double or triple daily for the next week or two. I am expecting 700-1500 cases of COVID in the US at the minimum.

There are 19 deaths.

[Daehawk]

Quarantine hotel in China collapses trapping 70

[gameoverman]

I am expecting 700-1500 cases of COVID in the US at the minimum.

I think the only thing limiting the number of new cases is the amount of testing being done. If they only test 1000 people per week in a country, you will not get more than 1000 new cases that week. It does not mean that only 1000 people were infected that week. It's like in the Chernobyl tv show where the meters they had only went up to 3.6. When the reading came back at 3.6 they said it wasn't great but it wasn't terrible, as if that number was the actual number instead of only as high as the meter could go. These tests results are our 3.6 reading.

[Kasey Chang]

There are 19 deaths.

I was going by UN report numbers which are like a day behind.

[Holman]

I live with my FIL, whose blood condition is bad enough to require frequent transfusions and whose immune system is seriously compromised.

Meanwhile, my own dad has just begun chemotherapy, making him highly vulnerable as well.

Every time one of these administration clowns tries to downplay the risks we're facing, I want to shotgun my monitor.

[Daehawk]

I think the flu killed over 60,000 last season.

[Blackhawk]

We also have follow OOers who are very high risk.

[Kraken]

I am expecting 700-1500 cases of COVID in the US at the minimum.

I think the only thing limiting the number of new cases is the amount of testing being done. If they only test 1000 people per week in a country, you will not get more than 1000 new cases that week. It does not mean that only 1000 people were infected that week.

I'm hearing that the US will hit peak panic this week. Until now, testing capabilities have been limited, the guidelines for who gets them have been narrow, and the federal government is trying to lowball that number. But now that test kits are being distributed en masse confirmed cases will quickly rise by hundreds, if not thousands. When Americans find out that the virus is widespread, we're going freak right out.

[Madmarcus]

Honestly it is because people don't understand the risk. At least, until the risk is already punching them in the face.

We're saying the same thing.

[Daehawk]

Saw Milam's quarantine. Mad rush for the last train out of what will become the red zone. Great quarantine..everyone leaves first.

[Combustible Lemur]

Saw Milam's quarantine. Mad rush for the last train out of what will become the red zone. Great quarantine..everyone leaves first.

I spent my last two days at work cautiously ttalking to people that there are about to be ALOT more cases. Since I work with teens and parents, I made sure to reinforce that you're not in danger really but grandma and grandpa have REAL risk. And that the spread they're seeing online right now is two weeks behind. They seemed very sober and mature about it.

Sent from my SM-N975U using Tapatalk

[Kasey Chang]

I want to shotgun my monitor.

Don't do it while drunk and live broadcasting

[Kasey Chang]

Right now, California is already panicking over Grand Princess, where AT LEAST 10 confirmed (probably dozens if not hundreds more) cases originated from one cruise ago. Yeah, landing test kits via helicopter and a rope is enough to scare everybody. Everyone is staying onboard and quarantined offshore, but plans are to bring them in on Monday where sick passengers will be transported to hospitals and non-sick ones will be transported into quarantine. Test results on those showing symptoms (45) revealed that 21 are sick... Mostly crew.

San Francisco Mayor Breed is banning "non-essential group events" for two full weeks on city-owned facilities. That includes various city-owned venues. Does that include baseball and basketball venues? They aren't sure yet. It'd be up to the respective leagues.

But this week will definitely be peak panic for the entire US, as the widespread testing will reveal how long this had been going around. I am expecting hundreds of new cases found each day.

In the meanwhile, new cases in China continues to drop... only 46 reported in the past 24 hours. Same in Korea... only 367 new cases, compared to almost 500 the day before.

But Italy and Iran both reported about 1100 new cases in past 24 hours (1247, or about 25% gain and 1067 about 15% gain respectively) and while US reported no new cases, it had to be lack of testing as CDC distributed new kits all over the nation. California news is reporting multiple cases confirmed all over the state.

EDIT: CDC numbers shows 164, well ahead of WHO's numbers (from yesterday, 62), concentrated in Washington State and California, with a third cluster around New York. That put the 11 deaths back into the proper... ratio.

[Daehawk]

2 more in TN.

I think if you go on a cruise now you're nuts. Some woman on the news is stuck on a ship and has stage 4 cancer she is supposed to get treatment for tomorrow...aint gonna happen. She was dumb to go on that cruise amid this thing. Anyone who plans to go on any cruise should simply add 30 extra days of sitting to their plans now and possibly being sick...or dying.

Ive always thought it would be a bug that gets the human species. Not this one. I think this one is far from the one that will take us down. But its coming. I think unless health and medicine and human thinking changes along with tech we have less than 1000 years.

[Daehawk]

CNN states 484 cases in US. 19 dead.

[Holman]

I think unless health and medicine and human thinking changes along with tech we have less than 1000 years.

Still, medicine tends to keep pace with other technological change.

You and I have probably already survived a couple dozen things that would have killed us two centuries years ago, and we didn't even notice most of them.

[Smoove_B]

https://twitter.com/TravelGov/status/12 ... wsrc%5Etfw

U.S. citizens, especially with underlying conditions, should not travel by cruise ship. #CDC notes increased risk of #COVID19 on cruises. Many countries have implemented screening procedures, denied port entry rights to ships and prevented disembarking.

[Smoove_B]

It's a bit lengthy and a little science-y, but it's the single best summary of where we are right now.

https://twitter.com/JeremyKonyndyk/stat ... 8985593857

With Italy quarantining millions and contemplating critical care rationing in hospitals, and Iran's health system in chaos, it's fair to ask if this is possible in the US.

Bottom line is: the longer we wait to act, the more likely it becomes.

I've made some charts.

[gameoverman]

I usually don't like reading Twitter threads but when I do I like them to be apocalyptic, and that one delivers the goods.

[Smoove_B]

Just got some updated documentation. The phrase for this week will be: "Self-Monitoring".

[Daehawk]

CNN states 484 cases in US. 19 dead.

550 and 21 now.

[Punisher]

San Francisco Mayor Breed is banning "non-essential group events" for two full weeks on city-owned facilities. That includes various city-owned venues. Does that include baseball and basketball venues? They aren't sure yet. It'd be up to the respective leagues.

Someone more knowledgable can correct me, but I don't see how this could possibly help.
500 people got to event 1 which is canceled. 20 of them are infected.
Event shuts down for 2 weeks, but maybe those 20 don't know they are infected for at least a week and still go around to stores and whatnot. During this period, they infect 100 more people.
2 weeks are up and event 2 starts on day 15. At that time 50 of the newly infected people who are maybe a week in and not showing symptoms yet or don't know they have the specific infection, go to the event and infect other people.

I can't really see how shutting down for 2 weeks can really help. I think if there is a concern, you shut down until 2-3 weeks after the last case has been reported in your area or not at all (unless you have a confirmed outbreak at an event and then you shut down to clean/quarantine your facilities.

For stuff like this, I'm thinking you go full China or you just let things happen as they will and 2 weeks would just make it worse by luring people into a false sense of security.

[Punisher]

2 more in TN.

I think if you go on a cruise now you're nuts. Some woman on the news is stuck on a ship and has stage 4 cancer she is supposed to get treatment for tomorrow...aint gonna happen. She was dumb to go on that cruise amid this thing. Anyone who plans to go on any cruise should simply add 30 extra days of sitting to their plans now and possibly being sick...or dying.

Ive always thought it would be a bug that gets the human species. Not this one. I think this one is far from the one that will take us down. But its coming. I think unless health and medicine and human thinking changes along with tech we have less than 1000 years.

I just spoke to my friend about this today. He runs security for an upcoming cruise along with a few other friends who go with him.
He is still waiting to hear if the cruise is canceled but seemed to think that if it wasn't, they were still going to go. I'm pretty sure that if I were on the detail with him, I'd be backing out. I guess when it gets closer we'll see if they cancel it or if he and the others back out.. I don't think he would because if they still do the cruise, he'd be afraid that they don't ask him to come back and he generally needs the money.
Even though he needs the money, I'm hoping they cancel on him so he's not in a position to have to choose.
(I've been asked to go to work a few times, but it requires a commitment WAAY in advance and I barely can commit to stuff 2 weeks from now. Plus I have a good-paying day job and the small amount of money I'd end up taking home isn't worth it. You have to pay for your flight to Florida any hotel you use pre-cruise and any other travel expenses. Your shifts are 10 hours and you are required at least 3-4 shifts depending on the length of the cruise. The main "benefit" you get is a free cruise, but I doubt I'd be able to enjoy it, plus it's an adult swingers cruise and that's not my thing either, so even without this virus thing, I wouldn't be going)
They also have the same type of event at a local hotel a few times a year. I have done a few of those when he first got the gig because he was short-handed for armed guards at the time so I did it to help him out, but even if I still did those, I don't think I'd go those either since there is nothing but bodily fluids getting swapped all over the place. The next one isn't for a few months though so who knows where we will be or if the hotel cancels it themselves.

[Madmarcus]

I'm with you. 4 weeks sounds like the right amount of time to really help break the cycle. On the other hand some events will not be rescheduled soon/this year which can lead to a similar effect.

[Punisher]

2 more in Jersey. Both near me.
My wife is a home health aide during the day and her patient is from Fort Lee and gets taken to a day center in Englewood with her daily for socialization, to get out of the house, etc... The center is currently discussing shutting, but nothing definitive yet.
She only needs to get by this week though as she is scheduled for hand surgery next week which will take her out of her day and night job for a while.

My son is also an EMT in the area and covers one of the towns and both hospitals of the 2 newly infected people, but nothing I can do for him and have to just trust he will take the correct precautions and be safe (His main hospital/company he works for has already gone over this with them and is keeping them in the loop. They already have full PPE (Personal Protection Equipment) on the rig and have been told to start using it if any symptoms are present (previously they would only need partial PPE like gloves and masks, they are now recommending that they use full PPE including face shields, gowns, and booties. (No full Hazmat equipment...yet...)
The hospital has also stated that there is still no reason for anyone to panic and that it is so far under control.
While I agree with that, I also know we have a ways to go and it will keep getting worse before it gets better.

Thankfully, I only need to worry about one of them cathing and bringing something home since I've worked from home for almost 2 years now (I miss and would rather be at the old office, which was sold though. Current situation notwithstanding.)

We haven't gone crazy with stocking up on stuff yet, except toilet paper. We had a bundle and a half and when my wife went to the store the other day, most of those aisles were empty so she picked up 2 more bundles, which is fine because we will use it and it's not like it goes bad.
I do normally stock up on Propel water and Gatorade Zero from Amazon. I usually buy about 10 or so full cases (each case is 4 sets of 6 bottles). I've been doing this for about a year now instead of just buying every couple of weeks.
I can no longer do this. Amazon is limiting me to 3 bundles of each, so not even a full case. I still have to see how often I can order them so I have some on hand for normal reasons. I've also seen that their normal 2-day shipping isn't anymore. I've had some things start to take 4-5 days now even when listed as Prime.
I can understand this though as I'm sure they are shorthanded from people being sick and whatnot.
I think that could be the biggest impact of this. Our shipping infrastructure. I don't think it would take much to overload it.. It' not like most places have a team of 10 truck drivers for each truck so a few drivers out of commission in an area mean delays in shipping in general. I'm mostly talking about 18 wheeler deliveries to hubs and endpoint stores/warehouses, but obviously things like the Post Office, UPS, Fed, Ex, etc.. can get crippled pretty easily.

[Punisher]

I'm with you. 4 weeks sounds like the right amount of time to really help break the cycle. On the other hand some events will not be rescheduled soon/this year which can lead to a similar effect.

Again,
Someone with better knowledge of how this all works in detail can correct me but I don't think that any arbitrary amount of time would help unless it's like I said X amount of weeks after the last know case. Even 4 weeks can run into my situation above if the new people get infected on the 3rd week, or the 23rd week if they pick 24 weeks.. It X would have to be the known period of incubation/when the virus runs its course and then tack on a week for good measure.
But this would mean to start locking everything down. Not just certain things. Even if one location shuts down for a year, but everything else is open and people are mingling, it won't help when that location opens a year later.
Things like this would mean having to go full China/martial law though, and this would probably need to be VERY VERY bad before anything like that happens. I'm also not sure how the average person would feel about that and depending on how long we are down, there would be a severe hit to our economy and way of life. Maybe something that would take a LONG time to recover from.
I think China was shut down for a month give or take?
Imagine 1 month where almost everything except essential services are shut down here. Most people out of work, most food places shut down. Maybe some supermarkets open, but even then, deliveries would dry up. I doubt the military has enough MREs to feed everyone for a month, so I would expect it to be as close to apocalyptic as we will come which is why I can't really see it happening. I do have more concern about certain businesses deciding to shut down on their own either due to fear or even a real threat like an outbreak at a location or just a lack of customers.
I work from home and pretty much everyone at my job would have that option as well, but since I do IT for an MSP, what happens when our clients start shutting down?
So, I really do think that IF this gets bad enough, the economical hit would be much worse.

[gameoverman]

Yeah the financial hits will be brutal if total shutdown is what happens. Some businesses will shut down and never reopen. Some self employed people will lose their gigs and those gigs might never come back. Not everyone has two weeks of financial resources to fall back on, lots of people might have to stop making various kinds of payments which means they'll fall deeper into the hole, and all that assumes it only lasts two weeks and people don't get sick. Even the flu can make it impossible to work. Imagine you are home for two weeks and right when you can go back to work you get sick and lose another week of pay.

[Alefroth]

Ive always thought it would be a bug that gets the human species. Not this one. I think this one is far from the one that will take us down. But its coming. I think unless health and medicine and human thinking changes along with tech we have less than 1000 years.

I think it'll probably be rats again. Especially with intimate contact becoming ever more popular.

[Victoria Raverna]

Ive always thought it would be a bug that gets the human species. Not this one. I think this one is far from the one that will take us down. But its coming. I think unless health and medicine and human thinking changes along with tech we have less than 1000 years.

I think something like that will save human species. Just look at the effect of COVID-19 on China. Work better at reducing pollution that anything that human can agree to do. If 50% of human population are killed by a Thanos virus, we can probably reverse the environmental damage and prevent climate change.

[Madmarcus]

Again,
Someone with better knowledge of how this all works in detail can correct me but I don't think that any arbitrary amount of time would help unless it's like I said X amount of weeks after the last know case. Even 4 weeks can run into my situation above if the new people get infected on the 3rd week, or the 23rd week if they pick 24 weeks.. It X would have to be the known period of incubation/when the virus runs its course and then tack on a week for good measure.

I'm not really someone with better knowledge but I think we are talking past each other. I'm talking about shutting down big gatherings in public owned places. I figure that those would be things like festivals, concerts, RV shows and the like. Since transmission depends on the number of people you interact with it makes sense to keep people from extra interactions. It's not perfect but it might be able to keep down the growth from a 1 - 3 - 9 - 27 - 81 to 1 - 2 - 4 - 8 - 16 which seems fairly big to me (numbers invented but as least sort of close to the r zero)

Realistically looking around in Korea I think it might be even more effectively then mentioned above. We're on about week 3 or 4 of having big public gatherings closed (including schools and churches). Things are mostly normal. I'm sure restaurants (and similar things like bars) are taking a hit but mostly people are going about life as normal just staying away from other people. Even in Daegu the lockdown hasn't been anything close to China. It seems to be working and the daily number of new cases is declining. I don't know if that would work in the US.

[hepcat]

Ive always thought it would be a bug that gets the human species. Not this one. I think this one is far from the one that will take us down. But its coming. I think unless health and medicine and human thinking changes along with tech we have less than 1000 years.

I think something like that will save human species. Just look at the effect of COVID-19 on China. Work better at reducing pollution that anything that human can agree to do. If 50% of human population are killed by a Thanos virus, we can probably reverse the environmental damage and prevent climate change.

That’s not saving us. If it was, we’d be celebrating wars and natural disasters.

[Dogstar]

Odd request -- other than CDC guidance, which I found, does anyone know of a plan for small businesses? Google hasn't been overwhelmingly helpful. Trying to balance office functionality with the guidelines as not everyone can telecommute. Practicality seems to be a real issue -- other than washing hands and social distancing, it's easy to envision a scenario where even a few employees self-quarantining can cause serious issues.

[Smoove_B]

Odd request -- other than CDC guidance, which I found, does anyone know of a plan for small businesses? Google hasn't been overwhelmingly helpful. Trying to balance office functionality with the guidelines as not everyone can telecommute. Practicality seems to be a real issue -- other than washing hands and social distancing, it's easy to envision a scenario where even a few employees self-quarantining can cause serious issues.

I haven't seen anything, no. All of the information I've come across is focused on schools and big business. Which is probably why when I was contacted by a camp on Friday morning, there was some confusion. Yes, there are camps still open and no, they haven't been given any guidance or assistance because no one is thinking about them.

The NSBA has posted some info, but you're correct - there's not much out there.

[Jeff V]

Ive always thought it would be a bug that gets the human species. Not this one. I think this one is far from the one that will take us down. But its coming. I think unless health and medicine and human thinking changes along with tech we have less than 1000 years.

I think something like that will save human species. Just look at the effect of COVID-19 on China. Work better at reducing pollution that anything that human can agree to do. If 50% of human population are killed by a Thanos virus, we can probably reverse the environmental damage and prevent climate change.

It took only 50 years for the world's population to double to what it is today. A sudden decline of that number would cause other catastrophes; understaffed nuclear plants might meltdown, fires raging unchecked, etc. Assuming civilization avoids going down the crapper, there's likely to be even more environmental damage done before reinvention starts to take hold, and by then we'll be right back to current population levels and dealing with the same challenges.

[Jeff V]

So yesterday I went to a Korean supermarket and was greeted by a valet who offered to wipe down my shopping cart handle with a disinfectant wipe and invited me to make use of the Purell dispenser mounted behind him. I had this feeling of standing in the middle of a river, torrents of water raging all around me with remnants of a dike with water dribbling out of a finger-sized hole...

[Dogstar]

I haven't seen anything, no. All of the information I've come across is focused on schools and big business. Which is probably why when I was contacted by a camp on Friday morning, there was some confusion. Yes, there are camps still open and no, they haven't been given any guidance or assistance because no one is thinking about them.

The NSBA has posted some info, but you're correct - there's not much out there.

Thanks, Smoove. One issue that's starting to crop up is whether self-quarantining or being sick in this situation triggers paid/unpaid sick day use absent clear federal and/or state directives, especially given the length of time that could be involved.

[Smoove_B]

Random internet opinion:

Spoiler:

Leave and Sick Pay Issues

If an employee is quarantined due to their own travel or exposure or to care for a family member for similar reasons, employers need to work through whether Family and Medical Leave Act (FMLA) or other leave laws apply to an employee’s absence. If the employee has exhibited symptoms and is required to be away from work per the advice of a healthcare provider or is needed to care for a family member, leave laws may apply to the absence. In contrast, if it is the employer’s implemented health and safety precautions that require the employee to be away from work, an employer should proceed with caution before designating any time away from work as leave under a specific leave law. Similarly, while multiple mandatory paid sick and safe time laws provide for paid time off benefits for situations involving illness and public health emergencies, many of these laws do not allow an employer to mandate the use such benefits. For example, the Washington State Department of Labor & Industries takes the position that an employee can never be required to use paid sick and safe time under Washington law; rather, the employee must be allowed to choose whether to use this benefit while absent from work. Further, employers should implement consistent protocols related to an employee’s reentry to the workplace in terms of obtaining a release clearing the employee to return to work and ensuring that the employee does not pose a risk to the health and safety of themselves or others.

And:

Spoiler:

Actively Encourage Sick Employees to Stay Home

The standard advice from public health agencies is to “encourage” sick employees to stay home. Sick employees may not feel that they can afford to stay home or that there will be adverse consequences for having a poor attendance record. To this end, employers should ensure their sick leave and attendance policies are flexible and consistent with public health guidance, modify them if appropriate, and communicate these policies and modifications to employees.

Employers may still require compliance with time and attendance policies requiring healthcare provider notes for absences if an employee is calling in sick, subject to applicable law. Employers may also require a fitness-for-duty release in certain circumstances, when an employee has been absent due to illness or as a result of any incubation leave. Whether an employer may require a fitness-for-duty release depends on the particular facts of the situation and should be assessed on a case-by-case basis. As the CDC points out, healthcare provider offices and medical facilities may be extremely busy and not able to provide such documentation in a timely way. If you have an employee who refuses to follow your incubation leave policy or have questions regarding return-to-work documentation, please contact an employment attorney to discuss.

And for anyone reading along, the CDC's position:

Spoiler:

Actively encourage sick employees to stay home:

Employees who have symptoms of acute respiratory illness are recommended to stay home and not come to work until they are free of fever (100.4° F [37.8° C] or greater using an oral thermometer), signs of a fever, and any other symptoms for at least 24 hours, without the use of fever-reducing or other symptom-altering medicines (e.g. cough suppressants). Employees should notify their supervisor and stay home if they are sick.
Ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies.
Talk with companies that provide your business with contract or temporary employees about the importance of sick employees staying home and encourage them to develop non-punitive leave policies.
Do not require a healthcare provider’s note for employees who are sick with acute respiratory illness to validate their illness or to return to work, as healthcare provider offices and medical facilities may be extremely busy and not able to provide such documentation in a timely way.
Employers should maintain flexible policies that permit employees to stay home to care for a sick family member. Employers should be aware that more employees may need to stay at home to care for sick children or other sick family members than is usual.

Separate sick employees:

CDC recommends that employees who appear to have acute respiratory illness symptoms (i.e. cough, shortness of breath) upon arrival to work or become sick during the day should be separated from other employees and be sent home immediately. Sick employees should cover their noses and mouths with a tissue when coughing or sneezing (or an elbow or shoulder if no tissue is available).

In short, uncharted waters. Sorry.

[em2nought]

So yesterday I went to a Korean supermarket and was greeted by a valet who offered to wipe down my shopping cart handle with a disinfectant wipe and invited me to make use of the Purell dispenser mounted behind him. I had this feeling of standing in the middle of a river, torrents of water raging all around me with remnants of a dike with water dribbling out of a finger-sized hole...

There were new automated Purell dispensers in front of two Walmart stores late last night.

[Punisher]

I haven't seen anything, no. All of the information I've come across is focused on schools and big business. Which is probably why when I was contacted by a camp on Friday morning, there was some confusion. Yes, there are camps still open and no, they haven't been given any guidance or assistance because no one is thinking about them.

The NSBA has posted some info, but you're correct - there's not much out there.

Thanks, Smoove. One issue that's starting to crop up is whether self-quarantining or being sick in this situation triggers paid/unpaid sick day use absent clear federal and/or state directives, especially given the length of time that could be involved.

I would think that if someone is out sick, they can take their paid sick days. If they will be out 2 weeks or longer, I wonder if they could apply for temp disability instead? (which would probably start a flood of claims for people with normal colds or flu as well since they are being told to stay quarantined to be safe.)
This is one of the economical issues I was talking about earlier. people just out of work for 2 weeks is about half their monthly income.
If this is a husband and wife who are both sick (or the scourge of married life, the dreaded hot potato of being sick), that could make the impact even worse. If you add children in the mix, what do I do if my child and wife are sick, but I'm not showing symptoms? DO I go to work anyway because my family likes to eat?